Nodular macroglossia with combined light chain and beta-2 microglobulin deposition in a long-term dialysis patient

We describe a case in which nodular macroglossia, a very rare type of tongu e involvement, tvas associated with the co-deposition of lambda light chain and beta-2 microglobulin fibrils in the tongue. The combined presence of t wo different amyloid fibrils did not lead to a more unfavourable clinical o utcome. The believe that both these features often remain underdiagnosed an d are in fact more frequent than reported. A careful clinical examination of the tongue together with serum immunofixa tion should be routine in all patients with dialysis-related amyloidosis in order to investigate the prevalence and type of tongue involvement and to rule out other types of amyloidosis, In all cases of suspected mixed amyloi dosis, immunohistochemical characterization of fibrils should be carried ou t by electron microscopy.